Fujii Kengo, Abe Tetsuya, Koda Masao, Funayama Toru, Noguchi Hiroshi, Miura Kousei, Kumagai Hiroshi, Nagashima Katsuya, Mataki Kentaro, Shibao Yosuke, Yamazaki Masashi
Department of Orthopaedics, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Japan.
Department of Orthopaedics, Tsukuba Univ. Hospital, Tsukuba, Japan.
J Clin Neurosci. 2019 Apr;62:229-231. doi: 10.1016/j.jocn.2018.12.033. Epub 2019 Jan 9.
The coexistence of lumbar intervertebral disc (IVD) herniation and cauda equina schwannoma in symptomatic patients is uncommon. We experienced a case with a surgically treated cauda equina schwannoma with concomitant lumbar IVD herniation (L2/L3); both were relatively small but presented with painful symptoms in combination. A 45-year old man complained of low back pain and right anterior thigh pain six months prior to surgery. He underwent conservative treatment; however, his pain suddenly worsened three months before surgery, with abnormal sensations and pain in his right buttock and posterior thigh. A magnetic resonance imaging (MRI) scan revealed an L2/L3 disc herniation extruding to the center of the lumbar spinal canal and compressing the thecal sac. Incidentally, an intrathecal tumor was suspected, and enhanced MRI revealed a round tumor measuring 10-mm in diameter at the L2/L3 intervertebral level, which was uniformly enhanced by gadolinium chelate, radiologically diagnosed as a schwannoma. Microscopic discectomy and tumor resection were performed and the patient's symptoms disappeared immediately. Schwannoma is generally slow-growing, and usually asymptomatic when the tumor size is small. Therefore, we suspected that the tumor occasionally impinged on the left L3 root with L2/3 IVD herniation, leading to acute worsening of the patient's symptoms. Altogether, in case of tumor in patients undergoing conservative treatment for cauda equina schwannoma, we should consider that symptoms can acutely worsen with the occurrence of lumbar IVD herniation.
有症状的患者中腰椎间盘（IVD）突出症与马尾神经鞘瘤并存的情况并不常见。我们遇到一例经手术治疗的马尾神经鞘瘤合并腰椎IVD突出症（L2/L3）的病例；两者相对较小，但合并出现疼痛症状。一名45岁男性在手术前6个月出现腰痛和右大腿前侧疼痛。他接受了保守治疗；然而，在手术前3个月，他的疼痛突然加重，右臀部和大腿后侧出现异常感觉和疼痛。磁共振成像（MRI）扫描显示L2/L3椎间盘突出至腰椎管中央并压迫硬膜囊。偶然间怀疑有鞘内肿瘤，增强MRI显示在L2/L3椎间水平有一个直径10毫米的圆形肿瘤，经钆螯合物均匀强化，影像学诊断为神经鞘瘤。进行了显微椎间盘切除术和肿瘤切除术，患者症状立即消失。神经鞘瘤通常生长缓慢，肿瘤较小时通常无症状。因此，我们怀疑该肿瘤偶尔会因L2/3椎间盘突出症压迫左侧L3神经根，导致患者症状急性加重。总之，对于因马尾神经鞘瘤接受保守治疗的患者，如果出现肿瘤，应考虑到腰椎IVD突出症的发生可能会使症状急性加重。
